Health Insurance Overview
West Virginia residents have multiple pathways to health coverage. With Medicaid expansion, low-income adults have access to free or low-cost coverage. Those with higher incomes can find affordable marketplace plans with subsidies through HealthCare.gov.
Medicaid in West Virginia
West Virginia's Medicaid program covers a broad population following the 2014 expansion:
- Adults ages 19-64 with income up to 138% of poverty (about $20,120/individual)
- Children under 19 (income limits up to 300% poverty through CHIP)
- Pregnant women with income up to 185% of poverty
- Seniors age 65 and older who meet requirements
- Individuals with qualifying disabilities
Mountain Health Trust
Most West Virginia Medicaid recipients are enrolled in the Mountain Health Trust managed care program. Through Mountain Health Trust, you'll choose a managed care organization that coordinates your healthcare, including:
- Primary care and specialist visits
- Hospital services
- Prescription medications
- Behavioral health services
- Preventive care
- Transportation to medical appointments
How to Apply for WV Medicaid
You can apply for West Virginia Medicaid through:
- Online: Visit WV PATH
- Phone: Call 1-877-716-1212
- In Person: Visit your local DHHR office
- Mail: Download and submit a paper application
Health Insurance Marketplace
West Virginia uses the federal Health Insurance Marketplace at HealthCare.gov. If you don't qualify for Medicaid, you can shop for private coverage with potential subsidies to reduce your costs.
How to Enroll
- Visit HealthCare.gov
- Create an account and complete your application
- See if you qualify for Medicaid or marketplace subsidies
- Compare plans available in your county
- Select a plan and pay your first premium
Average Costs and Subsidies
West Virginia residents have access to significant financial assistance:
- Medicaid: Free coverage for those who qualify (income up to 138% poverty)
- Premium Tax Credits: Available for income 100-400% of poverty (with enhanced subsidies potentially available above 400%)
- Cost-Sharing Reductions: Lower deductibles and copays on Silver plans for income under 250% poverty
- WV CHIP: Low-cost coverage for children in families with moderate income
West Virginia tends to have higher baseline premiums, which means subsidies are often more generous, resulting in low or $0 premium options for many residents.
Frequently Asked Questions
Has West Virginia expanded Medicaid?
Yes, West Virginia expanded Medicaid in 2014. Adults ages 19-64 with income up to 138% of the federal poverty level (about $20,120 for an individual or $41,400 for a family of four) can qualify for Medicaid coverage. Over 175,000 West Virginians have gained coverage through expansion.
How do I apply for West Virginia Medicaid?
You can apply for West Virginia Medicaid online through the WV PATH portal (wvpath.wv.gov), by phone at 1-877-716-1212, or in person at your local DHHR office. You can apply at any time of year - there's no enrollment period for Medicaid.
What is the Mountain Health Trust?
Mountain Health Trust is West Virginia's managed care program for Medicaid beneficiaries. Most Medicaid recipients in WV are enrolled in one of the Mountain Health Trust managed care organizations, which coordinate their healthcare services and benefits.
Can I get help paying for health insurance in West Virginia?
Yes, West Virginians have multiple options: Medicaid provides free coverage for income up to 138% of poverty, and premium tax credits are available on HealthCare.gov for income between 100-400% of poverty. Many residents qualify for $0 or low-cost plans through these programs.
Need Help Finding Coverage in West Virginia?
Our licensed agents can help you navigate Medicaid, Mountain Health Trust, or find the best marketplace plan for your situation.
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